SMI Determination Process October 20th, 2016

SMI Determination Process • What does it mean to be determined SMI or

eligible for SMI services?

Serious Mental Illness (“SMI”) is a description used in Arizona for people who need additional support because their mental illness impacts their ability to function.

• What is looked at (criteria/qualifications) to diagnose someone or determine if they qualify for SMI services?

To be eligible for SMI services (to get an SMI determination) a person must have both an SMI diagnosis and functional impairment caused by the qualifying diagnosis.

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Why go thru the SMI determination process?

• Eligibility for additional benefits, i.e. housing, assistance from Human Rights Advocates

• Continuity of Care with multiple providers (Co-Morbid issues, Integrated Care)

• Assertive Community Treatment (ACT), Intense Case Management

• Access to State Hospital Services, specialized Grievance and Appeals process

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What diagnoses are considered SMI? Psychotic Disorders

Bipolar Disorders

Obsessive-Compulsive Disorder

Depressive Disorder

Mood Disorders

Anxiety Disorder

Post Traumatic Stress Disorder

Dissociative Disorder

Personality Disorders

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How does the SMI determination process work? • TRBHAs and/or Crisis Response Network, Inc. (CRN) is responsible for

reviewing all applications for SMI services and making these determinations.

• A person can request to be evaluated/considered for SMI services, through their provider or their TRBHA.

• When a request is made, the provider/TRBHA will then complete an evaluation and an SMI Assessment Packet for each person.

• The Provider will then send the completed SMI Assessment Packet to CRN or TRBHA.

• The TRBHA and/or CRN will then review the packet and determine whether the individual is eligible for SMI services by following the State’s guidelines/criteria.

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Preliminary SMI Functional Criteria Inability to live in an independent or family setting w/o

supervision (Self Care/Basic Needs, hygiene, grooming, nutrition)

A risk of serious harm to self or others, persistent and acutely disabled

Dysfunction in role performance (school, work, community, trouble with developmentally appropriate responsibilities)

Risk of Deterioration (in the absence of proper treatment, social isolation, poverty, substance dependence, court orders, chronic medical conditions)

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or

SMI assessment

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• 2 Steps in the determination process: Assessment and Evaluation

• Assessment - The ongoing collection and analysis of a person’s medical,

psychological, psychiatric and social conditions in order to initially determine if a health disorder exists, if there is a need for behavioral health services, and on an ongoing basis ensure that the person’s service plan is designed to meet the person’s (and family’s) current needs and long term goals. TRBHAs, IHS and 638 facilities can conduct these assessments by qualified clinicians- A.A.C. R9-21-101(B).

• Evaluation- The process of analyzing current and past treatment information including assessment, treatment other medical records and documentation for purposes of making a decision as to a person’s eligibility for SMI services by a determining entity.

SMI determinations

Enrolled Members Determining Entity

Gila River Crisis Response Network

Navajo Nation Crisis Response Network

Pascua Yaqui Pascua Yaqui

White Mountain Apache White Mountain Apache OR Crisis Response Network

RBHA or acute contractor Crisis Response Network

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Contact Information • Crisis Response Network: (855)832.2866

• Pascua Yaqui: For members living in the Guadalupe area, please contact (480)768.2000 and ask for Centered Spirit

• White Mountain Apache: (928)338.4811

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Questions?

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Thank You

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